Voznyak Oleksandr, Hryniv Nazarii, Lytvynenko Andrii, Zinkevych Yaroslav
Centre of Neurosurgery, Clinical Hospital "Feofaniya", Kyiv, UKR.
Cureus. 2023 May 12;15(5):e38923. doi: 10.7759/cureus.38923. eCollection 2023 May.
Background and objective Double and multiple pituitary adenomas (PAs) are discovered in 2.6-3.3% of patients with Cushing's disease and in approximately 1% of autopsies. Undiagnosed and unremoved second PA may be the cause of unsuccessful surgical treatment of Cushing's disease. In this study, we aimed to describe our experience with the detection and treatment of patients with double PAs. Methods All patients in our series underwent transsphenoidal surgery (TSS) with endoscopic and neuronavigation assistance. Before 2017, we completely relied on MRI findings while planning surgery. From 2017 onwards, a broad revision of the sella turcica was conducted during surgeries regardless of the MRI data. Results Overall, 81 patients were included in the study: 51 before 2017 and 30 in 2017 after. In the pre-2017 group of patients, three out of 51 had double adenomas, and all of them were seen on MRI images. We encountered four more double PAs during the next period. Only two of them had been predicted by MRI. The remission rate was higher after 2017 and amounted to 90% (27 out of 30 patients). In contrast, before the implementation of total revision (pre-2017), our success rate was 82% (42 out of 51 cases). Both neoplasms in cases of double PAs yielded similar histological and immunohistochemical (IHC) features but were consistent with multiple PAs. Conclusions Although the improvement in our results in recent years cannot be clearly attributed to a targeted search for the second microadenoma, we still recommend performing a broad inspection of the sella turcica after the excision of the pituitary microadenoma regardless of preoperative MRI data.
背景与目的 双垂体腺瘤及多发性垂体腺瘤（PA）在2.6% - 3.3%的库欣病患者中被发现，在约1%的尸检中被发现。未被诊断和切除的第二个垂体腺瘤可能是库欣病手术治疗失败的原因。在本研究中，我们旨在描述我们对双垂体腺瘤患者的检测和治疗经验。方法 我们系列中的所有患者均在神经内镜和神经导航辅助下接受经蝶窦手术（TSS）。2017年之前，我们在规划手术时完全依赖MRI结果。从2017年起，无论MRI数据如何，手术期间均对蝶鞍进行广泛检查。结果 总体而言，81例患者纳入研究：2017年之前51例，2017年之后30例。在2017年之前的患者组中，51例中有3例为双腺瘤，且均在MRI图像上可见。在接下来的时期又发现了4例双垂体腺瘤。其中只有2例通过MRI预测到。2017年之后缓解率更高，达到90%（30例患者中的27例）。相比之下，在全面检查实施之前（2017年之前），我们的成功率为82%（51例中的42例）。双垂体腺瘤病例中的两种肿瘤具有相似的组织学和免疫组化（IHC）特征，但与多发性垂体腺瘤一致。结论 尽管近年来我们结果的改善不能明确归因于对第二个微腺瘤的针对性搜索，但我们仍然建议，无论术前MRI数据如何，在切除垂体微腺瘤后对蝶鞍进行广泛检查。
